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1746 PHARMACY CORP
DSH330350 UNIVERSITY HOSPITAL OF BROOKLYN
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL OF BROOKLYN
Subdivision Name
SUNY DOWNSTATE MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330350
Entity Address
445 LENOX ROAD
Attn: Pharmacy Box 36
BROOKLYN, NY 11203
Medicare Provider Number
330350
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
1746 PHARMACY CORP
Pharmacy Address
DBA: CLARKSON PHARMACY
524 CLARKSON AVE
BROOKLYN, NY 11203-2015
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/4/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
William Walsh, CEO
(718) 270-4293
Contract Pharmacy Representative
Arshad Tariq, COO
(718) 774-1656
Signed By Date
1/15/2015
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